Anti arrhymic medication

[Babyr1996]

Hi all

Had telephone appointment with cardiologist- a new one has joined our team he couldn’t understand why I was on ivabradine as it has no affect on AF I couldn’t answer that one he asked why I wasn’t on beta blockers I explained about my very low blood pressure and that they knocked BP down too much & made me pass out etc. He is going to try me on Diltiazem but can still drop BP but not as much if that fails then to try me on Flecainide as pill in the pocket or Amiodatone. Anti arrhymic meds had never been discussed with me before (and my diagnosis was back in 2006)

Having read up about both these I’m in a dilemma ad to which to chose if I have too? What do you all think who finds which one the best obviously this is to gather info on effectiveness side affects etc etc & I shall have an informed discussion with cardiologist when the time comes.

What I can’t understand is in all this time why have these not been considered before oh and just to say I have duel chamber pacemaker

Chads vac score is 1

Thanks for input & info

[BobD Volunteer]

Firstly it is important to understand that any and all treatment for AF is only about quality of life. You have a pacemaker which will ensure that your heart beat does not drop too low on any drugs. If the feeling of the fibrillation is distressing it may be why your new cardiologist has suggested anti-arrhythmic drugs other wise rate control would seem the most sensible approach especially if you AF is continuous.

Amiodarone is generally the drug of last resort as it is said not to have side effects. It has effects! It is a toxic drug best avoided if possible. Flecainide and Propafanone are both commonly used rhythm control drugs and the latter does have some beta blocking capabilities to slow your heart rate.

It really depends on your quality of life and how symptomatic you are.

[Babyr1996 in reply to BobD]

Hi Bob

Thanks for all that - makes perfect sense. AF is real bad atm having lots of high heart rates and QOL is almost well nil really. Struggling but holding in as we do. He says the AZ vaccine has most likely upset things as apparently it can bring on AF as this all started up again after my 1st vaccine and got worse gone as high as 172bpm. It gets very painful with the constant high rate as we all know it’s exhausting.

Thank you for your wisdom as ever

[Babyr1996]

Hi

Thank you for your input much appreciated

[secondtry]

On my Lone PAF diagnosis, I was 60yo (now 67), active with sports etc, my pulse was under 60 and my BP 115/63. My cardiologist put me on 200mgs Flecainide and nothing else with it, despite me checking twice whether I should have a BB or CC as a safety measure in case of rapid heart beat. He was adamant that it would make me feel unwell and so the situation has remained the same for 7 years and I have been fine.

I know nothing about pacemakers but maybe you should discuss the Flecainide options - although a strong drug it is a relative old tried and tested one and I believe its bad side is more prevalent for post 70yo with comorbidities.

[wilsond]

Yes my neighbour has been on dronedarone for several years and it really helps her.

[Ducky2003]

My EP tried me on Flecanide about 4 years ago but I lasted 3 days on it with my heart trying to escape from my chest, but it works wonders for some folk. I have been on Amiodarone, on and off since, especially prior to any cardioversions, as that's kept me in NSR following them. Currently still on it 11 weeks post ablation and likely to be for another couple of months at least. I di have corneal deposits but am told these should go once the Amiodarone is stopped completely. I'm also on Diltiazem post ablation but I do get side side effects with that to so its swings and roundabouts.😊.

[Foulplay]

I was on flecanide for about one month . It caused numerous irregular heart beats dizziness and high heart rate for me . My Dad has been on it 25 years . It has been a miracle drug for him. He has not had one episode of afib. My husband was recently diagnosed with afib. 2 cardioversions later he is only on metoprolol succinate . It is controlling his afib. He was having the too low of blood pressure problem with dizziness . They changed his blood pressure medicine and he is fine now. It’s funny how each of us is different . What works for one doesn’t for another.

[buddje]

You need an Electrophysiologist

[Joannemcfc]

Hi I have been on flecainide for 14 years and it’s been great although the last couple of years it’s not as effective so my doctor put me on a beta blocker along side the flecainide and it works for me. The side effects from the BB were quite grim at first but now i have got used to them it’s working well if I get an episode of SVT I would take an extra flecainide as a pill in the pocket

[Quinney]

I’ve had great results with Flec. Prior to being on it I was on only a beta blocker (Metoprolol)for rate control. When I started Flec I cut down Metoprolol to 25mg twice a day. The combination of rate and rhythm drugs keeps my AF/Flutter in check. I am in my 60s and physically active leading a normal life. Flec side effects for me are minimal - some mild vision disturbance. I have no experience with Amiodorone. (Sp?)

Flec in my opinion is worth a try.

[Babyr1996]

Thank you everyone it does help hearing how you all get on or not with either of these

Really appreciate your feedback

[Bruceyboy]

I had. Bradycardia and very fit but would go into Afib when HR dropped below 40 Had Pacemaker installed which meant HR would not drop below 50 Was put on Sotalol but made me breathless and didn’t put me into SR Am on Apixaban but have weaned off Sotalol as I am in Permanent Afib Cycle 100-150 kms/ week Gym for core walk dog 7-8 kms a day and have bushwalking group Almost don’t know I am in Afib so am lucky Also previously tried Flecanide but didn’t agree with me

[Babyr1996 in reply to Bruceyboy]

HiThank you thats similar to me I have Bradycardia my HR will fall as low as 37 bpm had positive tilt table test hence duel chamber pacemaker mine is set to if it drops below 50 or over 160bpm cos I can go from end to the other. I was out on Bisoprolol which dropped my HR & BP so had to come off that then now I’m on ivabradine midodrine and fludrocortisone to raise BP to not much avail the highest recorded over 3 years is 110/70 and that’s after exerhertion. My average BP is 93/44 but has dropped as low as 73/44 so usually hovers somewhere between the 2. AF well that’s a whole new story had ablation for flutter only as AF had settled for some time 3 years ago later this year. Now cardio wants me to stop ivabradine even though it was to raise BP and try Diltiazem as ivabradine is no good for people with AF - don’t ask I get confused if that don’t work then it’s to try either Flecinaide or Amiodarone to control the now AF

Thank you